Opioid-Free Anesthesia for Mandibular Surgery in a Patient With Confirmed Opioid Hypersensitivity: A Case Report

Opioid-induced anaphylaxis is a rare but potentially life-threatening condition that represents a major challenge for perioperative pain management. We report the case of a 38-year-old woman with confirmed hypersensitivity to fentanyl and sufentanil, who underwent mandibular cyst resection under exclusive systemic opioid-free anesthesia. Following a previous aborted surgery due to an anaphylactic reaction during induction, allergy testing confirmed opioid hypersensitivity, while other intravenous anesthetics tested negative. Anesthesia was performed using a multimodal systemic approach combining dexmedetomidine, ketamine, lidocaine, magnesium sulfate, dexamethasone, and paracetamol, without regional anesthesia. Intraoperative hemodynamic parameters remained stable, and no allergic or anesthetic complications occurred. Postoperative pain was acceptable and managed with non-opioid analgesics, and patient satisfaction was high. This case highlights the feasibility of a fully systemic opioid-free anesthetic strategy in maxillofacial surgery for patients with confirmed opioid allergy.